Gabriele Bocchialini

Introduction: Traumatic injuries are the leading cause of death among <40 year olds, a good part of the working age population. Traumatic injuries are also the leading cause of lost productivity, causing more lost working days than cancer or vascular cardiomyopathy. Materials and Methods: We retrospectively and statistically analyzed the characteristics of facial fractures treated between June 2010 and December 2016 at the Maxillofacial Adult Surgery Unit, Spedali Civili Brescia, Italy. Discussion: Facial fractures are common in polytrauma patients, due to exposure of the cephalic end. The incidence of concomitant facial injuries with major trauma is 15%–24% in England (between Liverpool and London) and up to 34% in Washington, based on a large database of 87,174 patients. High-energy trauma frequently involving multiple traumatic injuries often leads to complex facial fractures, affecting different portions of the splanchnocranium. Conclusions: Treatment of facial fractures often focuses on functional or esthetic outcomes, and the outcomes are often substantially worse than those of other trauma treatments. Given the esthetic value of the face, facial trauma often leads to heightened emotional distress.

Facial trauma is an enormous public health problem with overwhelmingly negative physical and psychological impacts. The authors retrospectively analyzed the incidence, etiology, clinical presentations, and characteristics of facial fractures along with sociodemographic, economic, and cultural factors. They analyzed facial fractures treated from June 2010 to December 2016 at the operative unit. Maxillofacial Adult Surgery Unit, Spedali Civili Brescia, Italy, with particular attention to the associations among age, etiology, fracture site, and clinical management.

Introduction: Osteomas are slow-growing benign tumours composed of mature compact or cancellous bone and are seen in facial bones but uncommonly in the mandible; cases that arise in the notch region are rarely reported in the literature. Presentation of case: This article presents a 37-year-old woman with no preauricular swelling, no limitation of joint motion and pain only on the left side. Discussion: The patient was evaluated based on preoperative clinical manifestations, orthopantomography and a computed tomography (CT) scan. The CT scan showed bone density irregularity between the coronoid process and the left mandibular condyle in the notch region arising both medially and laterally. Surgery was performed based on these images and the patient's indications and symptoms. Conclusion: Among the cases of osteoma in the literature, only six originated in the mandibular notch, but this is the only that was both medially and laterally located. Highlights:

Chronic nonbacterial osteomyelitis (CNO) or chronic recurrent multifocal osteomyelitis (CRMO), is a very rare condition of unknown aetiology. It is characterised by focal sterile inflammatory disease with prolonged, self-limiting and recurrent episodes. We report the discovery of this very rare disease following a mandibular abscess in a 10-year-old female. We initially focus on the difference between the preoperative orthopantomography and the maxillofacial computed tomography and magnetic resonance images obtained, and then on the improvement of strategies for correct diagnosis and treatment of this disease. Bone pain and localised swelling can occur in a single bone or can spread to soft tissue and adjacent bone; areas commonly affected by CMRO include the metaphyseal plates of the long bones, as well as the spine, clavicle and, rarely, the maxillofacial area. The clinical presentation of CMRO includes pain, functional impairment, and swelling, similar to our case. We report a very rare case of this unifocal mandibular disease in a child who presented for an abscess and was then diagnosed and treated for CNO.

Subcutaneous emphysema is rare during or after dental procedures (usually extractions). Here, we describe the case of a 65‐year‐old woman who developed massive cervicothoracic subcutaneous emphysema and pneumomediastinum during a dental hygiene procedure employing an artificial airflow. She was diagnosed based on clinical manifestations and computed tomography (CT). CT revealed massive subcutaneous emphysema extending from the superior left eyelid to the diaphragm. We describe the clinical and radiological characteristics of this rare case.

INTRODUCTION: Gorham-Stout disease (GSD), or vanishing bone disease, is a very rare condition of unknown aetiology. It is characterised by progressive osteolysis and angiomatosis. CASE PRESENTATION: We report the discovery of this very rare disease following a trivial deciduous tooth extraction in a 14-year-old female. We focus initially on the difference between the preoperative orthopantomography and the whole-body computed tomography and magnetic resonance images obtained post-haemorrhage, and then on the improvement of strategies for the correct diagnosis and treatment of this disease. DISCUSSION: Bone loss and the proliferation of vascular structures can occur in a single bone or spread to soft tissue and adjacent bone; areas commonly affected by GSD include the ribs, spine, pelvis, skull, clavicle, and the maxillofacial area. The clinical presentation of GSD includes pain, functional impairment, and swelling, although a few asymptomatic cases have been reported, similar to our case. CONCLUSION: We report a very rare case of this multicentric disease in an asymptomatic child who presented for dental extraction, almost died, and was then diagnosed with and treated for GSD. Highlights:

INTRODUCTION: Major haemorrhage developing during oral or maxillofacial surgery is uncommon, but potentially life-threatening. Dental extractions in childhood are common, but blood loss is unusual. CASE PRESENTATION: Here, we report a rare case of a complication developing during a trivial deciduous tooth extraction. We focus on the great difference between the preoperative orthopantomography and the maxillo-facial computed tomography obtained post-haemorrhage. DISCUSSION: The surgical procedures most commonly associated with acute haemorrhage are orthognathic, oncological, and temporomandibular joint procedures. When acute haemorrhage develops, the surgeon must remain calm, temporarily arrest the bleeding, and ultimately definitively control it. Although ligation of the offending artery, vein, or vascular malformation is clearly the treatment of choice, identifying the offending vessel and gaining adequate access thereto are often difficult. CONCLUSION: We emphasise that what we encountered could happen in routine daily practice. Highlights:

Branchial cleft cysts are benign lesions caused by anomalous development of the branchial cleft. Cases that arise in the lateral neck region are often misdiagnosed, resulting initially in inappropriate management. We describe a 32-year-old woman with a swelling on the right side of her neck and no pain during palpation or neck motion. The patient was evaluated using fine-needle aspiration cytology (FNAC), ultrasound, and magnetic resonance imaging (MRI) scans. The MRI showed a right-sided cervical mass with hyperintense content, well-defined margins, and no evidence of infiltration into surrounding structures, while FNAC found a yellow, pus-like fluid, keratinised anuclear cells, squamous epithelium, and a matrix of amorphous debris. Based on the images and the patient's symptoms, a surgical intervention was performed.